The development, validity and applicability to practice of pharmacy-related competency frameworks: A systematic review

Background: Global reforms in the education of health workers has culminated in the implementation of competency-based education and training (CBET). In line with the CBET model, competency frameworks are now commonplace in the health professions. In pharmacy, these frameworks are used to regulate career entry, benchmark standards of practice and facilitate expertise development. / Objective: This systematic review assessed the development, validity and applicability to practice of pharmacy-related competency frameworks. / Method: PubMed/Medline, CINAHL, Embase, ERIC, Scopus and PsycINFO electronic databases were searched to identify relevant literature. Additional searching included Google Scholar, electronic sources of grey literature, and the Member Organisation websites of the International Pharmaceutical Federation (FIP). The findings of this review were synthesised and reported narratively. The review protocol is registered on PROSPERO with reference number CRD42018096580. / Results: In total, 53 pharmacy-related frameworks were identified. The majority (n=39, 74%) were from high income countries in Europe and the Western Pacific region, with only three each from countries in South East Asia (SEA) and Africa. The identified frameworks were developed through a variety of methods that included expert group consultation used alone, or in combination with a literature review, job/role evaluation, or needs assessment. Profession wide surveys and consensus via a nominal group, Delphi, or modified Delphi technique were the primary methods used in framework validation. The competencies in the respective frameworks were generally ranked relevant to practice, thereby confirming validity and applicability. However, variations in competency-related terminologies and descriptors were observed. Disparities on perception of relevance also existed in relation to area of practice, length of experience, and level of competence. For example, pharmaceutical care competencies were typically ranked high in relevance in the frameworks, compared to others such as the research-related competencies. / Conclusion: The validity and applicability to practice of pharmacy-related frameworks highlights their importance in competency-based education and training (CBET). However, the observed disparities in framework terminologies and development methods suggest the need for harmonisation

The effectiveness and impact on performance of pharmacy-related competency development frameworks: A systematic review and meta-analysis

BACKGROUND: Competency frameworks for education, training and development are widely used in the health professions, including pharmacy. Published studies suggest that competency frameworks have an impact on professional performance. Professional performance that is consistent with up-to-date knowledge and skills influences health care quality and patient safety. This review assessed the effectiveness of competency frameworks in facilitating improvement in pharmacists' performance. METHOD: PubMed/Medline, CINAHL, Embase, ERIC, PsycINFO and Scopus electronic databases were searched to identify relevant literature. The findings of the included studies were synthesised qualitatively, and via a meta-analysis. The meta-analysis evaluated the odds of improved competency behaviour as a proxy measure of impact on pharmacists' performance. Study quality was assessed using 12 criteria adapted from the EPPI-Centre guidelines v0.9.7. The protocol for this review is registered on PROSPERO with reference number CRD42018096580. RESULTS: In total, nine interventional studies were identified for review. The review findings showed observable and significant improvement in pharmacists' performance when competency frameworks are used to appraise performance, identify knowledge gaps, and tailor learning activities. A meta-analysis that involved a total of 348 pharmacists undergoing repeat peer assessment showed pooled odds for improved competency behaviour of 4.41 (95% CI: 1.89-10.29, I2 = 83%). Subgroup analyses showed pooled odds with corresponding 95% CI of 6.50 (1.77-23.97, I2 = 77%) vs 2.95 (0.59-14.72, I2 = 93%) for the studies that were conducted in countries within or outside Europe, respectively; 10.51 (3.73-29.62, I2 = 24%) vs 2.39 (0.96-5.95, I2 = 87%) for studies with reassessment conducted at ≤6 months from baseline, or more, respectively; 6.68 (1.63-27.45, I2 = 88%) vs 2.80 (0.86-9.07, I2 = 74%) for studies involving hospital or community pharmacists, respectively; and 2.80 (1.22-6.45, I2 = 77%) for studies with low risk of bias. CONCLUSION: These findings suggest competency frameworks facilitate improvement in pharmacists' performance; however, further evaluative studies are needed

The Evolution of Bat Vestibular Systems in the Face of Potential Antagonistic Selection Pressures for Flight and Echolocation

PMCID: PMC3634842This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Stronger diversity effects with increased environmental stress : a study of multitrophic interactions between oak, powdery mildew and ladybirds

Recent research has suggested that increasing neighbourhood tree species diversity may mitigate the impact of pests or pathogens by supporting the activities of their natural enemies and/or reducing the density of available hosts. In this study, we attempted to assess these mechanisms in a multitrophic study system of young oak (Quercus), oak powdery mildew (PM, caused by Erysiphe spp.) and a mycophagous ladybird (Psyllobora vigintiduo-punctata). We assessed ladybird mycophagy on oak PM in function of different neighbourhood tree species compositions. We also evaluated whether these species interactions were modulated by environmental conditions as suggested by the Stress Gradient Hypothesis. We adopted a complementary approach of a field experiment where we monitored oak saplings subjected to a reduced rainfall gradient in a young planted forest consisting of different tree species mixtures, as well as a lab experiment where we independently evaluated the effect of different watering treatments on PM infections and ladybird mycophagy. In the field experiment, we found effects of neighbourhood tree species richness on ladybird mycophagy becoming more positive as the target trees received less water. This effect was only found as weather conditions grew drier. In the lab experiment, we found a preference of ladybirds to graze on infected leaves from trees that received less water. We discuss potential mechanisms that might explain this preference, such as emissions of volatile leaf chemicals. Our results are in line with the expectations of the Natural Enemies Hypothesis and support the hypothesis that biodiversity effects become stronger with increased environmental stress

Adaptação do inventário parental “Language Use Inventory (LUI)” para crianças entre 18 e 47 meses para o português europeu : estudo piloto

Language acquisition and development takes in account the child’s interaction with the surrounding environment. Daily social interactions with people and communication with others allow the child to acquire language being pragmatics considered a system of rules that support the communicative use of language. Identification and assessment of children at risk for language disorders are crucial in order to carry out an effective early intervention. This study was carried out taking into account first, the relevance of pragmatics as a component of language, and second the lack of assessment tools in Portugal to assess these abilities. Therefore, the aim of this study consists on the translation, adaptation and validation of the inventory “Language Use Inventory” (LUI), to European Portuguese. The LUI is a standardized parent report measure designed to assess pragmatic language development in children within 18- to 47-month-old.Objetivo: A aquisição e o desenvolvimento da linguagem resultam da interação da criança com o meio ambiente. As interações sociais cotidianas com as pessoas e a comunicação com outros permitem que a criança adquira linguagem, sendo a pragmática o sistema de regras que suporta o uso comunicativo da linguagem. A identificação e a avaliação de crianças em risco de desenvolverem transtornos de linguagem são cruciais, tendo em vista a intervenção precoce eficaz. Tendo em vista a relevância da pragmática como componente da linguagem e a escassez, em Portugal, de instrumentos de avaliação da linguagem validados para idades precoces, a finalidade deste estudo consistiu na tradução, adaptação e validação do instrumento Language Use Inventory (LUI), para o português europeu. O LUI é um inventário parental que avalia o desenvolvimento da pragmática entre os 18 e os 47 meses. Métodos: Foram adotados todos os procedimentos recomendados pelas diretrizes internacionais sobre a adaptação de testes, culminando em estudo piloto com uma amostra de 120 inventários, respondidos pelos pais/cuidadores de crianças portuguesas da referida faixa etária. Resultados: Os coeficientes de consistência interna (Alfa de Cronbach) para a versão portuguesa do LUI situaram-se em 0,97 para a escala total e entre 0,71 e 0,96 para as subescalas. Conclusão: Os resultados preliminares dos estudos de adaptação e de validação do LUI-Pt para crianças portuguesas são promissores e asseguram a validade interna desta escala em termos da sua dimensionalidade e consistência interna

Prolonged Exposure to a Mer Ligand in Leukemia: Gas6 Favors Expression of a Partial Mer Glycoform and Reveals a Novel Role for Mer in the Nucleus

Mer tyrosine kinase is ectopically expressed in acute lymphoblastic leukemia and associated with enhanced chemoresistance and disease progression. While such effects are generally ascribed to increased engagement of oncogenic pathways downstream of Mer stimulation by its ligand, Gas6, Mer has not been characterized beyond the scope of its signaling activity. The present study explores Mer behavior following prolonged exposure to Gas6, a context similar to the Gas6-enriched microenvironment of the bone marrow, where a steady supply of ligand facilitates continuous engagement of Mer and likely sustains the presence of leukemic cells. Long-term Gas6 exposure induced production of a partially N-glycosylated form of Mer from newly synthesized stores of protein. Preferential expression of the partial Mer glycoform was associated with diminished levels of Mer on the cell surface and altered Mer localization within the nuclear-soluble and chromatin-bound fractions. The presence of Mer in the nucleus is a novel finding for this receptor, and the glycoform-specific preferences observed in each nuclear compartment suggest that glycosylation may influence Mer function within particular subcellular locales. Previous studies have established Mer as an attractive cancer biologic target, and understanding the complexity of its activity has important implications for potential strategies of Mer inhibition in leukemia therapy. Our results identify several novel features of Mer that expand the breadth of its functions and impact the development of therapeutic modalities designed to target Mer

Correlation versus Causation? Pharmacovigilance of the Analgesic Flupirtine Exemplifies the Need for Refined Spontaneous ADR Reporting

Annually, adverse drug reactions result in more than 2,000,000 hospitalizations and rank among the top 10 causes of death in the United States. Consequently, there is a need to continuously monitor and to improve the safety assessment of marketed drugs. Nonetheless, pharmacovigilance practice frequently lacks causality assessment. Here, we report the case of flupirtine, a centrally acting non-opioid analgesic. We re-evaluated the plausibility and causality of 226 unselected, spontaneously reported hepatobiliary adverse drug reactions according to the adapted Bradford-Hill criteria, CIOMS score and WHO-UMC scales. Thorough re-evaluation showed that only about 20% of the reported cases were probable or likely for flupirtine treatment, suggesting an incidence of flupirtine-related liver injury of 1∶ 100,000 when estimated prescription data are considered, or 0.8 in 10,000 on the basis of all 226 reported adverse drug reactions. Neither daily or cumulative dose nor duration of treatment correlated with markers of liver injury. In the majority of cases (151/226), an average of 3 co-medications with drugs known for their liver liability was observed that may well be causative for adverse drug reactions, but were reported under a suspected flupirtine ADR. Our study highlights the need to improve the quality and standards of ADR reporting. This should be done with utmost care taking into account contributing factors such as concomitant medications including over-the-counter drugs, the medical history and current health conditions, in order to avoid unjustified flagging and drug warnings that may erroneously cause uncertainty among healthcare professionals and patients, and may eventually lead to unjustified safety signals of useful drugs with a reasonable risk to benefit ratio